Resuscitation

1
(No Transcript)
2
Resuscitation

• The goal of resucitation is
• to maintain adequate oxygenation and perfusion.
• An sequence of events should be instituted
  beginning with the ABC

3
Resuscitation (best survival)

• Children with a respiratory arrest .
• a short duration of CPR.
• and a pulse present at the time of apnea.

4
Signs and symptoms suggesting the potential need
for resuscitation

• CNS
• lethargy ,irritability ,confusion
• Respiratory
  apnea ,grunting
  ,nasal flaring ,tachypnea , poor air
  movement ,stridor ,wheesing

5
Signs and symptoms suggesting the potential need
for resuscitation (2)

• Cardiovascular
• Arrhythmia ,bradicardia, weak pulses ,poor
  capillary refill , hypotention
• Skin and mucous
• Mottling , pallor , cyanosis , diaphresis ,
  poor turgor , dry mucouse membranes

6
Resuscitation

• Responsiveness
• Gently shake if no injury
• Speak loudly
• Call out for help
• Position the patient
• Place supine
• Keep neck immobilized

7
Resuscitation

• Basic life support (BLS)
• A irway
• B reathing
• C irculation
• Advanced life support (ADL)
• Airway Breathing Circulation Drugefluid

8
ABC

• An sequence of events should be instituted
  beginning with the ABC
• Opening Airway
• Assessing Breathing
• Assessing Circulation

9
Respiratory support

• Head tilt/chin lift or jaw thrust if the
  cervical spine is unstable .
• Looking for the rise and fall of the chest.
• Listening at the nose and mouth for breathing.
• This should be done in the less than 10 seconds

10
Rescue breathing in an infant
11
Head tilt- chin lift maneuver
12
Combined jaw thrust-spine stabilization maneuver
13
Rescue breathing in a child
14
Mask

• Smallest size face mask
• Large enough Resuscitation Bag
• Assess for mask leak
• Monitor patient response
• Sellicks maneuver
• O2

15
Sellicks maneuver
Compression of the cricoid cartilage
backward compressing the esophagus against the
Vertebral to prevent aspiration Of gastric
contents
16
Indication for endotracheal intubation

• Apnea , Airway obstruction unrelieved by airway
  opening maneuvers.
• Increased work of breathing that may lead to
  fatigue.
• The need for PEEP
• Poor airway protective reflexes .
• Sedation or the need for paralysis

17
Intubation

• Laryngoscopy

18
Intubation

• reoxygenate with 100 O2
• Gasteric tube
• Check devices
• Position the patient
• ETT size (mm) 16 age in yr
• 4

19
Nasopharyngeal Airway

• Appropriate Nasopharyngeal Airway
• Apply Phenylephrine before nasopharyngeal Airway
• Concave side facing inferiorly
• Insert Oral airway
• O2

20
?????? ?? ?? ???????? ??????? ??????? ??? ?? ??
???? ??????? ??????????.
21
Foreign body aspiration

• A conscious child suspected a foreign body
  should be permitted to cough spontaneously
  until
• coughing is not effective
• Respiratory distress and stridor increase
• the child becomes unconscious

22
(No Transcript)
23
(No Transcript)
24
Foreign body aspiration
Abdominal thrusts with victim Standing or
sitting( conscious)
25
Foreign body aspiration
26
Neonatal resuscitation

• High risk situations should be anticipated by
• ? history of the pregnancy .
• ? labor and delivery.
• ? identification of signs of fetal distress .

27
Neonatal resuscitation

• 5-10require some degree of resuscitation
• Goals are
• prevent the morbidity and mortality with
  hypoxic-ischemic injury .
• Re-establish adequate spontaneous respiration and
  cardiac output

28
Neonatal resuscitation

• ? IF Persistent cyanosis or failure to
  ventilate or HR lt 60
• Depressed respiratory neuromuscular.
• Airway malformation.
• Lung problem (pneumothorax diaphragmatic
  hernia).
• ? Congenital heart disease.

29
Apgar evaluation of newborn

• Sign 0
  1 2
• Heart rate absent
  lt100 gt100
• Respiratory effort absent
  irregular,slow crying, good
• Muscle tone limp some
  flextion active motion
• Response to catheter no Grimace
  cough,sneeze
• Color blue,pale body
  pink completely pink

30
Apgar evaluation of newborn

• Apgar score is helpful in evaluating patients in
  need of attention .
• Apgar 0-3 represent either cardiopulmunary
  arrest , a condition caused by severe bradicardia
  ,hypoventilation , CNS depression
• Infants born
• limp , cyanotic , apneic , or pulseless
  require immediate resuscitation

31
???? ???? ?? ?? ???? ?????????? ???? ????? ???.
32
endotracheal intubation

• sever respiratory depression who dont respond
  to ppv via bag and mask.
• who was born apneic.
• Pulseless.
• Cyanotic and limp
• Low Apgar score
• Evidence of a diaphragmatic hernia

33
Neonatal resuscitation

• Clear of meconium?
• Breathing or crying?
• Good muscle tone? color pink?
• term gestation?
• ?? If yes routine care ,warmth ,
  clear air way ,dry
• ?? If no warmth , position , Clear
  airway, dry , stimulate,
• reposition , give o2
  
• and then Evaluate
  respiration , HR ,and color

routine care ,warmth , clear air way ,dry
34
(No Transcript)
35
Neonatal resuscitation

• Apnea or HRlt100 provide positive pressure
  ventilation
• HRlt 60
  HRgt60
• Provide ppv
• Administer chest compression

HRgt60
Continue p pv if HRgt100 Discontinue p pv
Provide p pv initiate chest compression
Initiate medication if lt HR 60 After30 sec of p
pv and o2 And chest compression
color
36
Neonatal resuscitation chest compression

• If the HR does not improve after 15-30 sec with
  bag and mask (or endotracheal) ventilation
  and remains lt 60/min
• or the rate is lt80/min and not rising
• ? ventilation chest compression 120/ min
  with
• com / v 3/1

37
Chest compressions in Infants(lt1 y/o)

• One finger below intermammary line
• 3th4th fingers on sternum
• 1/3 to1/2 depth of chest
• 100 times per min.
• 5 Compressions to 1 ventilation

38
Chest compressions in Infants(lt1 y/o)
39
Cardiac compressions ( infant)
40
???? ????????? ????? ??????? ???? ????? ???? ????
?? ??? ?????? ??
?? ???? ?????? ????? ?? ???? ?????? ????.
41
(No Transcript)
42
Assess for signs of circulation

• Check pulse(3-5 sec.)
• Use brachial or femoral in infants
• Use carotid in childgt8 yr
• Chest compressions
• neonate 120 1-8yr andgt8 100
• Comprassion /ventilation
• neonate 31 1-8yr51
• gt8yr152
• 
  
  

43
(No Transcript)
44
Poor response to ventilation in neonates AND
children may be due to

• ?- Loosely mask , Positioning of the tracheal
  tube , air in stomach
• ? -airway obstruction , insufficient pressure ,
  pleural effusion.
• asystole , hypovolemia
• pneumothorax, diaphragmatic hernia
• ? prolong intrauterine asphexia

45
Medication in Neonatal resuscitation

• Medications rarely required .
• ?? Medication should be administered
• if HR is lt than 60 /min after 30 sec of
  ventilation and chest compressions .
• During asystole.

46
Medication in Neonatal resuscitation

• ?? drugs
• Epinephrine 0/1 03 /cc/kg of i/10,000( repeated
  every 5min)
• Volume expansion isotonic crystalloid
• Bicarbonate 1-2 m Eq/kg (1mEq/kg/min)
• Calcium gluconate 2-4cc/kg
• Dopamin and dobutamine in shock

47
Intra osseous infusion
48
Intraosseous infusion
49
Chest compressions in child(1-8 y/o)

• One fingerbreadth above xyphoid-sternal margin
• Heel of hand
• Depth2.5-4 cm.
• 100 Times per min.
• 5 Comp. / 1 Vent.

50
Chest compressions
51
Chest compressions in a child
52
Chest compressions in child(gt8 y/o)

• Two hands
• Depth 3-5 cm.
• 80-100 Times per min.
• One rescuer 5 Comp. / 1 Vent.
• Two rescuer 15 Comp. / 2 Vent.

53
Medication for cardiac arrest

• Epinephrine 0/01mg/kg iv/ io
  (1/100000/1cc/kg)
• 
  0/1mg/kg ET (1/10000/1cc/kg)
• 
  Administer every3-5min
• Atropine 0/02mg/kg Min
  dose0/1mg iv,io,ET
• Bicarbonate 1mEq/kg infuse slowly
  if ventilation is adequate
• Calcium gluconate 60-100mg/kg
  (0/6-1cc/kg) iv/io
• Glucose(10-25) 2-4cc/kg

54
Brain death

• No spontaneous movement or interaction with
  enviroment
• No response to stimuli ( pain ,light ,sound ,
  touch )
• Absence of brain stem reflexes
• Apnea .
• All of the criteria should be present at
  least 6-24 hr after coma and apnea .
• Silence EEG ,no hypothermia and
  cardiovascular shock and drug intoxication

55
Femoral veinanatomy
56
(No Transcript)
57
Cardiovascular support

• Chest compression must be given
• If there is no pulse
• If the pulse is less than 60/min with poor
  perfusion
• Chest compressions are given without interrupting
  ventilation

58
"If you love life, life will love you back." !